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Wrigley hoping to expand 'Medicaid Fraud' unit

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North Dakota Attorney General Drew Wrigley wants to expand the office’s Medicaid Fraud Unit.

That unit was created in 2019. Former Attorney General Wayne Stenehejm had been pushing for years to have such a unit – but found resistance in the Legislature. The 2019 Session finally passed it.

Originally, the unit was 90 percent federally-funded, 10 percent state funded. But Wrigley said the formula is now 75 percent federal, 25 percent state.

"Just in the 10 months that I've been here, we've reclaimed, in fraudulently obtained dollars, enough money to more than finance the entire biennium," Wrigley said in an interview. "It's not there are a profit center — it's there to detect and punish, and ultimately deter, fraud."

Wrigley says the unit has a budget of $1.2 million over a two-year period.

Wrigley said fraud can take many forms. One is “upcoding.”

"They're billing for something that wasn't even rendered," Wrigley said. "It was not just mis-coded."

Wrigley said the unit is also focused on maltreatment in Medicaid-funded facilities. And he said there are what he called “diversion” cases.

"That's where doctors are mis-prescribing, over-prescribing, prescribing when there isn't a need — whether it's opioids or other narcotics — they can make it into the black market, and help fuel the already troubling the opioid abuse epdiemic," Wrigley said.

Wrigley said the unit has six people – one attorney, two BCI agents, auditors and support staff. He said he will be asking for more staff.

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